Saturday, September 23, 2017

Single Payer: Myths cured by the experience of Taiwan


An acquaintance of mine with a decade of life here posted this on Facebook about single payer. Here in Taiwan we have excellent health insurance. If only the US had this system, instead of its current one or the murderous plans the Republicans keep attempting to pass....

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I wrote this while on a recent train ride. It's long, but please don't think I'm crazy. I was bored and motivated at the same time.

This is on my mind a lot, and I only share because I think it can add clear perspective to a very confusing and clouded health care debate.

As someone who has lived under one version of Single Payer Health Care for the past 10 years, I would like to respectfully opine on some of the (many) falsehoods that are circulated by various (mostly conservative media) sources. I think it's totally cool no matter what opinion you hold.

I just hope to add to an informed and important debate.

So, about Single Payer -
- SP is not government-owned health care. Doctors do not necessarily work for the government. SP is priced and paid out by a single government-pooled source, and care is administered in the private sector (usually).

- SP does not stifle choice. I can literally go to any doctor/hospital/clinic in any city. Nobody is limited to doctors within their 'plan' or even geographical area. I usually pick the place with the best candy bowl at the desk.

- SP does not stifle competition. I have found SP to be far more of a 'free market' of care than I have ever experienced in the US (see above re choice). The best doctors and the best clinics get and retain the most patients and therefore make the most money.

- SP is kindof a socialist idea, sure, but really it's very much capitalist in the sense that the actual care is the service/product delivered by the physicians rather than the insurance 'plan' (see above). Associating SP with Venezuelan-style socialism is an oft-used farce that makes no sense. I think it's important to remember that every variation of US health care over the past several decades can neither be described as socialist nor capitalist, but rather, "rigged".

- SP does fix pricing at the national level, in a very good way. If this worries you, I can understand that. This worries me much less than how pricing of care and medicine has been handled in the US in recent history. Remember the insurance bills with all the fake prices? What was that all about?

- SP does not force doctors to provide services under the threat of force or law...any moreso than police are 'forced' to keep the peace. This is mostly in response to a guy named Ben Shapiro and many outlets that have repeated his ideas. I have no idea what he is talking about.

- SP does not ration care to the extent that has been described over and over in the US media. Wait times for vital care are not a problem. I'm sure there are outlier situations where patients were unhappy with care or not cared for properly, but I can say for certain that long wait times and rationing of care are definitely not systemic of SP in Taiwan.

- SP is not unaffordable. It is definitely cheaper than any recent version of US health care. Way cheaper. That's just math.

- SP does not require you to "pay for other people's health care" any more than any health care proposal that the GOP has presented over the past several months...unless we start allowing insurance companies to price customers out again (which the GOP is trying to do now)....in which case, people who run out of money will simply get the care and not pay for it (again, we all end up paying for that), or just die.

- SP is popular and it works, but the most important endorsement I can think of is this - For those who have experienced BOTH the US system of care and SP in some variation in a foreign country and are able to compare and contrast, the vast majority would favor SP. (see "Candian citizens who have lived in the US")

- SP has many different variations and hybrids, and amenities and aesthetics of care centers will usually fall in line with cultural expectations. In Taiwan for example, some hospitals and clinics lack a modern feel and may seem uncomfortable to someone who is used to more bells and whistles. That's because Taiwanese households, in general, do not have a lot of bells and whistles.

- SP is very good for small business and the working individual. Imagine a world where your health care has nothing to do with your employer. Imagine starting your own business and not having to worry about employee health benefits for that first person you hire.

- SP acknowledges that health care is a right. I know, it's not written in the constitution or whatever. Does anyone have a pen?

- SP also acknowledges that there is no solution to health care in the true free market. The nature and inelasticity of health care as a good makes it a lot different than sneakers and cell phones. I think that's just something we all have to accept.

- SP works very well in many countries. That doesn't mean it will have the same efficiency if implemented in the US. It could be even BETTER in the US. Because 'Merica.

- SP is not perfect. No health care solution is perfect.

- SP is not a curse. It can be a blessing.
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16 comments:

Anonymous said...

In the US, when people talk about Single Payer (SP) Health Care, they usually draw their ideas (the pros and cons) from the experiences in Canada and, to lesser extent, in the UK.

The Canadian system totally fits the bill of the SP opponents in the US; namely, in Canada:
- SP IS government-owned health care. Doctors DO necessarily work for the government. No out-of-system clinics and hospitals are allowed.
- SP DOES stifle choice. One CANNOT literally go to any doctor/hospital/clinic; referrals are required to see physicians that are not General Practitioners.
- SP DOES stifle competition: there is no competition.
- SP does fix pricing at the provincial level, such that some medicine school graduates LEAVES for the US to earn a better living.
- SP DOES ration care so that one wait for 6-12 months for an MRI scan or to see a specialist.

For full-report on the 2015 status in terms of Health-Care Wait-Time in Canada, see (link to PDF file):

https://www.fraserinstitute.org/sites/default/files/waiting-your-turn-2015.pdf

Taiwan is not on the radar of the white-predominant discussion of health care system in the world. Taiwan is "third-world" and non-white. Who would want to draw it into a "serious" discussion, let alone seeing it as a model; what an insult?!

Only "first-world" countries count. Canada is one of them. That's why Canada's model is the prototype of Single Payer system in the US discussions (or rather, noises.)

Bias? It goes on many levels. Factual discussion? Forget it!

cephaloless said...

About forcing medical providers to serve, I don't remember Ben Shapiro talk about single payer but I do remember him talking about whether healthcare is a right or a service (that must be paid for). So I disagree that health care is a right because that would lead to doctors being compelled to provide service. But by your description of a well functioning SP system, that's not necessary. Health care service is made affordable and accessible by SP. It's not that the patient walks in demanding to be treated because it's his right but that he has no problem paying for his reasonably priced health care.

The right vs service talk may be louder recently from situations such as that baker who is being compelled to bake a cake for a same-sex wedding, and that's not even a right.

Anonymous said...

I am curious as to everyone's opinion.
From a physician or health care provider's point of view, do you guys think that SP will cause the physicians to be overworked? Isn't this happening in Taiwan? I've heard that Taiwanese health care providers are more stressed and work longer hours compared to other countries.

Shultz Lu said...

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

Taiwan was indeed modeled in this frontline TV series in 2008 when Obamacare was in the heat of debate.

Shultz Lu said...

Taiwan was one of the model countries in 2008 Frontline TV series "Sick around the world". Obamacare was in heated debate and Congressional action later.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

Shultz Lu said...

The Fraiser Institute is a libertarian, conservative think tank in Canada. It has received donations of hundreds of thousands of dollars from foundations controlled by Charles and David Koch, with total donations estimated to be approximately $765,000 from 2006 to 2016. It also received US$120,000 from ExxonMobil in the 2003 to 2004 fiscal period. In 2016, it received a $5 million donation from Peter Munk, a Canadian businessman.

Anonymous said...

I usually agree with your your analysis Mike, but on SP, I think you are delusional. When I have time I'll try to post again, point by point, on your comments. In the meantime, this is a good/lengthy read: The Bill to Permanently Fix Healthcare for All


Anonymous said...

I do believe health care is a right will become the dominating view worldwide. How to properly compensate and maintain healthy working environment for the health care professional is a separate issue. As far as I know, not a single doctor in democratic society is been forced by government to provide care.

Even for those Republican politicians who try to repeal Obamacare, they still claim that they can offer affordable health care for "ALL". "For all" mean health care is a right in my opinion.

All of us do get sick at sometime, and we all understand how uncomfortable and painful some sickness can be. Getting sick is very very different from eating a cake. Using the example of bake a cake for a same-sex wedding as an argument in health care discussion is not convincing.

Shultz Lu said...

Taiwan was one of the model countries in 2008 Frontline TV series "Sick around the world". Obamacare was in heated debate and Congressional action later.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

Michael Turton said...

I usually agree with your your analysis Mike, but on SP, I think you are delusional. When I have time I'll try to post again, point by point, on your comments. In the meantime, this is a good/lengthy read: The Bill to Permanently Fix Healthcare for All

The plan you link to is a just another subsidy program for the institutional investors in private insurance, the usual transfer of wealth from ordinary people to elites, which is the real function of private health care. SP is the only rational way, which is why every civilized nation uses it.

Michael

Anonymous said...

Having lived here 20 years, i couldn't see anything that i factually disagree with.
For those of you outside Taiwan it works like this: there is a yearly fee and a visit to the doctor usually runs from 50 nt to 150 nt ($US2~6). Basically less than lunch at KFC.
I had surgery here, total cost, less than $US500.
HEALTH CARE is not one of my worries. That is THE GOAL.

Anonymous said...


Mike, your Bernie Sanders/Never Trump leftist viewpoints are tiring. I don't think you get what is happening in the USA. Sorry, but you've lost me as a longtime follower.

cephaloless said...

Any comments on medical tourism? Does that throw anything off? I doubt it makes a big enough dent to be noticeable but you're the man on the ground.

At one of the anonymous's up there, I just used the good testament of Taiwan's SP Health Care to eliminate one of the opponent's main contention with it. Leave it alone since the results are the same, just less opposition to negotiate to reach that result. Health care is not a right but access to health care (I'd like to consider affordability part of this) is absolutely a right. Yes, there is a difference.

Anonymous said...

I think the question of whether it's a "right" or not just confuses the issue. The question is whether or not it's good for the majority of citizens of a country without causing unfair strain on the remainder, and IMO it clearly is. As you mention early on, the system is rigged by those who have tailored it so that they are the financial beneficiaries.

Tim said...

https://en.wikipedia.org/wiki/First_World

I personally would prefer factual discussion.

Michael Turton said...

Anonymous cephaloless said...
Any comments on medical tourism? Does that throw anything off? I doubt it makes a big enough dent to be noticeable but you're the man on the ground.


Medical tourism is an interesting issue. To implement it, there needs to be slack resources -- rooms not being used, doctors with nothing to do, etc. The system is based on population quotas -- area with population Z gets Y beds and W doctors. So ideally there is no slack. But in practice, doctors and hospitals can squeeze some out of the system.